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Interview notepad

Health Care Professionals Talk About Overcoming Overeating

Allen King and Dana Armstrong

Sit down, relax and start listening to yourself." That's the non-technical, straightforward advice Allen King, M.D. endocrinologist, gives to his patients with diabetes. King, a partner at King, Revers & Winn Medical Group in Salinas, Calif., and Dana Armstrong, a registered dietitian and certified diabetes educator, are determined to keep people with diabetes, hypertension, and high cholesterol—especially those whose disease is coupled with a tendency for overeating—living as normal a lifestyle as possible.

There is a high incidence of compulsive eating problems in patients with diabetes. "When you impose upon a compulsive eater the diagnosis of diabetes, and add to it the need for rigid control of sugar intake, meal timing and reduction of fat, then people start going crazy," King said. "Or they say, 'the hell with it' and disassociate themselves from the disease and say 'It doesn't bother me, I don't exist in my body anymore.'" King sees that response frequently.

"Most of my patients tell me 'I want to lose weight NOW!'" King comes back at them with, "There's no way to lose weight NOW, and if you try, it will probably cause you to GAIN WEIGHT NOW." King and Armstrong review their patients' attempts at losing weight through dieting and diet plans and remind them how much weight they've actually gained back in the process. "Almost all of them tell us that they ended up weighing more in the end than they did in the beginning. Our awareness of that gives us further credibility in their eyes, and further underscores the idea that it is impossible to diet to lose weight," King says.

Dr. King's family history is one of chronic battles with compulsive eating, weight loss, diabetes and other related diseases. As a professional, he began to investigate these areas. Initially, he thought obesity was caused by lack of knowledge. He gave patients an outline of the caloric content of foods. In a follow-up period of four weeks to four months, the average patient lost eight ounces. Half gained weight! Next he tried behavior modification and recruited a dietitian to provide a more individualized diet. In a three-month follow-up, the average patient lost only five pounds.

With the popularity of liquid diets and their initial great success, Dr. King then tried rigidly controlled programs. Over 500 patients were placed on diets of 500 to 1,000 calories per day with behavior modification. The average patient lost 50 pounds in six months; Dr. King felt that he had finally succeeded. A three-year follow-up, however, uncovered an average 60-pound regain. Certainly, he thought, what was needed was more control.

Gastric surgeries were unacceptable due to the mortality and morbidity rate. Anorexic medications—diet pills—were of limited use. Two patients who elected jaw wiring lost weight initially, then regained. The Garren Gastric bubble seemed the ideal solution—a plastic balloon inflated in the stomach. Weight loss did occur, but only in patients who developed ulcers and bowel obstructions.

"I became disillusioned and found myself avoiding discussing diet approaches with patients. Each method was followed by failure, and worse, guilt on the patient's part for 'failing,'" King said. That is, until Dana Armstrong joined the Medical Group and started to research Overcoming Overeating. She began dismissing diets as a legitimate way to make an impact on medical conditions or to solve eating problems.

"Until you accept that you have diabetes, or any other condition, the doctor will always control the disease. You won't be the boss of your diabetes and you won't be able to experiment with it. You own your weight, and it is part of you in all it's beauty," King says as he explains his master plan for dealing with disease. "You can't get to C unless you go through Steps A and B. Step A is self-acceptance. Step B is self-love or trusting yourself. If you love yourself, you'll show it by demonstrating that you can take care of yourself. Taking care of yourself is not only with respect to monitoring and controlling your blood sugar—it's making sure your needs are being met. If your particular need is food, then you need to take care of that. You need to develop a trusting relationship with the person inside of you in order to be able to sit with your feelings rather than feed mouth hunger."

"The biggest hurdle is to get people with diabetes to slow down and start accepting themselves. I remind them that diabetes is a genetic problem. Gaining weight through compulsive eating and dieting will exaggerate diabetes, but it's not your fault that you have the disease. You just drew a bad card out of the deck when you were born. So you have to learn how to play that particular poker hand in life. It helps to understand the disease and get rid of the guilt aspects."

The second hurdle is to calm people down. People who have diabetes need to know that they, not their doctors, are in control of their disease. King and Armstrong work to give their patients the necessary tools to take care of themselves. One tool is the ability to figure out where you are with your diabetes and your sugar. People with diabetes need to be informed and educated about their condition. Otherwise there is little understanding or motivation as to why they should change their behavior or how change could help improve the condition.

Armstrong, along with Rhonda Howard, R.D., C.D.E., use this same philosophy in all their diet and nutrition education. Regardless of the problem—diabetes, HDL, cholesterol, high blood pressure—no diet restrictions are given. Diets lead to weight gain which generally results in an exacerbation of the disease. Instead, they educate patients about their disease and provide information as to how certain foods will affect them physically. This allows the individuals to make and understand their own food choices, thereby taking control of their disease.

In addition to conducting individual consultations and an eight-class series on Overcoming Overeating, Armstrong teaches a series of six classes on living with diabetes. One of the six classes is dedicated to food and eating. "Most people with diabetes can relate to the fact that they're out there binge eating, not testing their blood sugar and not following any clinical or doctor's recommendations or doctor's diet or any of those types of things," Armstrong points out.

"All of a sudden, they'll get the notice in the mail to go to the doctor and get a lab test done in order to get more medicine. So they pull it all together and become very restricted for a while so that the numbers look pretty good on the test. As soon as that visit is over, they walk out the door and are back to the old ways of thinking and acting." As she describes this scenario in her class, the attendees nod in agreement.

Armstrong's effort to educate those with diabetes has become a personal one. Armstrong's own home atmosphere is dedicated to listening to and understanding one's body and hunger. Diabetes education doesn't stop when she leaves the office. Her five-year-old son Steven, who has insulin-dependent diabetes, along with her own history of yo-yo dieting and binge eating are constant reminders of the necessity for demand feeding.

"We try to make our patients their own bosses," King says. "If you tell yourself you can't have chocolate cake on your birthday because that will raise your blood sugar, you'll probably end up overeating or eating the cake at some point but with great guilt. I'll say 'go ahead and have the chocolate cake.' Experiment with food under controlled circumstances, someplace where you can monitor yourself and take time to ask yourself how you really feel after you've eaten it."

"When your blood sugar is high or your cholesterol level is elevated, it's the same thing as experiencing pain from a cavity in your tooth. Your body is giving you an indication of what's going on," Armstrong says. "Often, when people haven't eaten fat or cholesterol-containing foods, they have this real desire to binge on them. I tell these people to bring these foods into the house and "legalize" them. Try them and ask yourself, 'Do I really like the taste? How do they make my body feel?' If you don't really commit to legalizing the foods, it won't work. Your body is giving you certain signals associated with the disease process. You need to be very, very in tune to those signals."

"Most people still have that 'Doctor is God' mindset," says Armstrong, who is described by King as an energetic go-getter type of person. "Allen King is my medical support. He backs me 100% and helps people challenge dieting. I think that it's very powerful when your physician is helping you and is preparing people to come in to see you. We work together as a team; I provide the detailed part of the work and he provides the emotional support and stability. It would be so much harder to do this without physician support. He lends a huge amount of credibility to what I do. We're part of a team, but Allen's the head cheerleader by far."

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